The Prostate Cancer Revolution

Beating Prostate Cancer Without Surgery

Robert L. Bard

• Publisher: Morgan James Publishing
• ISBN:
  9781614489061
• Topic: Medicine
• Subtopic: General Health

The Prostate Cancer Revolution opens with a call to change the way prostate cancer is viewed, diagnosed and treated. In practical terms, readers learn the facts about changing world of cancer treatment, diagnosing prostate cancer using sophisticated imaging technologies, noninvasive precision image-guided treatments to eradicate prostate tumors, how readers can guide their personal health choices, the value of alternative approaches for cancer control and total health.

CHAPTER 1

TAKING THE RISK TO CHANGE

11 PM. Emergency Department. Metropolitan Hospital. New York City, 1973. Twenty-six year old female brought in with stab wound to the chest and increasing shortness of breath. Medical team must know if there is bleeding into the pericardium, the sac that holds the heart. I confer with the heart surgeon, leave the ED and proceed to the obstetrics department. I bring back an ultrasound machine used on a pregnant woman’s abdomen for determining fetal growth and place the scanner over the heart of the bleeding patient. With clear images of the extent of the injury, the patient is rushed to the OR. The surgeon, now armed with a precise picture of the site of the hemorrhage, targets his operation. The bleeding around the heart is stopped at 1:00 AM. The patient lives.

This real life story shows that a medical technology dedicated to a single use may have other potential uses. Eye scanners were used on the breast in 1978 to perceive mammary problems. Breast scanners looked at joints and tendons in 1990. Tendon imaging devices that showed blood vessels and demonstrated actual live blood flow near a joint were adapted to imaging the prostate in the mid 90’s. Scanners, showing the face of the fetus using 3-Dimensional (3-D) pictures inside the uterus fifteen years ago, were soon placed on the shoulder and knee to assess injuries. Technology that improved shoulder imaging with 3-D pictures became available for the prostate ten years ago. For a while, medical imaging was mainly limited by the lack of curiosity of the physician and the paucity of semiconductor technology to make more powerful computer chips. Medical breakthroughs are sometimes as simple as thinking outside the box. There are similarities between the resistance of medical science to embrace innovations in diagnosis and treatments, and the tendency of individual persons to resist embracing constructive new ideas and behaviors. To understand how an entire profession can be slow to welcome advances, let’s first examine human nature.

The following story of the “Rat and the Cheese” illustrates a how a laboratory animal changes its habit when experience showed the behavior was no longer meaningful. A rat was put in a tunnel with a piece of cheese at the end. The rat ran down the tunnel and ate the cheese. Day after day the rat was able to wend its way down the course to find unerringly the tasty morsel. One day the cheese was removed. The rat went down the tunnel and tried to find the cheese. The next day the rat entered the tunnel and searched without success. The third day the rat went into the tunnel and came out without any cheese. At the end of the fourth day the rat refused to enter the tunnel.

The difference between rats and human beings is this: the rat quickly learned what worked and what did not work, while people often continue outmoded or futile behavior patterns despite the absence of tangible rewards. For example, if one goes into a room full of people and asks those who are 10 pounds or more overweight to raise their hands, and then asks those who know that exercise and dieting will control their weight to raise their hands—the same hands go up. Being overweight is not rewarding physically or psychologically. Those who raise their hands know better, yet that knowledge is not sufficient for them to override their self-destructive habits.

Here’s another example from nature. Do you know hunters trap wild monkeys? You see, these primates are similar to humans in important ways. A banana is put into a jar with a narrow neck. The monkey reaches into the jar and grabs the banana in his closed fist. The width of the clenched hand with the banana is wider than the jar opening. As the hunter comes to catch the monkey, the animal gets frantic, but will not let go of the banana. All it has to do is give up its grip—simple, but the monkey’s instinct to hang onto food interferes with its ability to risk letting go for a greater good.

Unlike the rat, people often don’t listen to their own experience. Instead, like the monkey, they cling to old ways. In particular, men may avoid dealing with health issues due to denial based on fear—will the treatment be worse than the disease (impotence or incontinence)? A man’s first approach to a medical problem is to wait, hoping it will go away. When the condition worsens, he waits again hoping his health won’t deteriorate further or that his body’s natural immune defenses will come to the rescue. Finally, when he can no longer put up with the alteration of his lifestyle, the entreaties of his concerned wife or the intolerance of his physical state, he decides to get help. FEAR stops men from being proactive in their health. Women complain about the inconvenience of mammograms, yet few miss their yearly appointments. In fact, demand is so great that in New York City the current wait time for this often uncomfortable test is up to 6 months.

What’s behind the fear of seeing the doctor? Patients who delay seeking medical help fall into four risk-avoidance categories:

1. The stoic, who sees sickness as unmanly or a sign of weakness
2. The worrier, who knows too much about possible medical side effects
3. The ostrich, who is in denial
4. The victim, who gets attention from others for maintaining suffering.

Then there is the perfect patient, who overcomes his fear or anxiety and attends to potential problems early.

Fear thwarts and contradicts our natural need for survival, just as the monkey gave up the long-term survival of freedom for the short-term gratification of having a banana. Fear is a physiologic byproduct of our concerns over pain, interruption of daily routine by long waits, extensive recovery periods, and possibly, death. For countless men, the idea of seeing a doctor activates these concerns. “White collar hypertension” (high blood pressure) is a real phenomenon. Our blood pressure often rises in the doctor’s office with the stress of a possible serious medical condition. Relaxing and deep breathing usually lowers the number to a safe level. Other causes of fear in the doctor’s office are bad childhood experiences, claustrophobia, fear of needles, fainting at the sight of blood, low pain threshold, cold examination rooms, exposing parts of the body, etc.

No matter what kind of patient you are and no matter what your fear of the unknown, don’t wait till it is too late. Today’s technologies and treatments are minimally invasive, removing the threat of catastrophic side effects. Thus, taking the risk to overcome this fear is one of the safest choices you can make! Tell the physician and his staff about your anxiety and request specific arrangements. For instance, while no one objects to a prostate sonogram, many men wince at the thought of being inside the claustrophobic MRI tube for half an hour. For these concerns, we may modify the procedure to keep the head outside the tube or inject anti-anxiety medicine to reduce the stress of the procedure. Newer MRI machines can reduce the scan time in half.

Here’s a perfect example of the greater risk of waiting too long to seek medical help. A colleague in good health developed heartburn and treated it with antacids for two weeks. When it got worse and the acid rose up in his throat irritating the throat and voice box producing hoarseness, he called the gastroenterologist. The GI doctor told him to fast after midnight and see him at 8 AM the next morning for an endoscopy, a scope inserted through the mouth that looks at the esophagus and stomach. He had a light dinner and started the fast earlier at 10 PM. After the anesthesia wore off from the procedure, he was told the test couldn’t be performed because the stomach had not emptied and the retained food contents blocked the view of the endoscope. He knew in a flash that common causes for an obstruction preventing emptying of the stomach were either a severe duodenal ulcer or cancer of the outlet end of the stomach. Since he had no real pain, he was sure he had a malignancy. He consulted me and we arrived at the understanding that worst possible outcome, cancer, might still be in an early stage. The test was repeated after a 12 hour fast and a small benign ulcer of the stomach wall was discovered which resolved in a month under routine treatment. The moral is: it is better to deal with your worst nightmare promptly than to procrastinate and lose the opportunity for a relatively painless curative treatment. The ancient philosopher, Seneca, said “pars sanitatis velle sanari fuit” or “the wish to be cured is part of the cure.”

Now let’s look at how the field of medicine often resists innovation, just as individuals are prone to do. After all, physicians are human, too. While we try to do the best for our patients, doctors are slow to let go of customary ideas and even slower to accept new concepts. Medical practitioners rightfully demand proof that a change from a tried and true routine will make sense before adopting a new method, but how much proof is “enough”? My former partner and late colleague, Dr. Selig Strax, Professor of Surgery at Mount Sinai Medical Center in New York, also commented on the tendency of the medical profession’s avoidance of change. Half a century ago, he introduced the first “lumpectomy” operation (to remove a malignant tumor while conserving the breast) at Mount Sinai. It took a quarter century longer for this proven method to be uniformly adopted throughout the national medical community. The original radical mastectomy surgical operation, removing the entire breast, chest wall muscles, and occasionally part of the rib cage, was based on the 100-year old idea that cancer spreads in linear progression to nearby tissues. After the discovery that small cancers could infiltrate the lymph nodes (glands) and from there spread widely to every other organ through the blood stream, did the radical mastectomy cease? No. For the next thirty years this mutilating procedure was the gold standard of breast cancer therapy in spite of growing proof that it had outlived its purpose. Breast surgeons clung to their traditional methods, nor was there much demand from patients. Why? Before the Information Age when computers and the internet became commonplace, women didn’t have easy access to accurate and understandable information about the lumpectomy procedure. Today’s prostate cancer patient, on the other hand, is armed with the internet, the news media and national prostate cancer support groups and programs. Men need not acquiesce to their doctors who recommend one specific treatment or dictate their own preferred therapy. The information revolution allows men to research and choose the best available medical options for their particular condition and level of comfort with the stated potential risks. Think about how you would like your life after prostate cancer to be. As Einstein once put it, “Imagination is more important than knowledge”

If I propose the “prostate lumpectomy,” how long will it take the scientific community to consider the possibility? This book proposes simple, straightforward and logical alternatives to currently accepted “gold standard” conventional treatments. Many of these advanced alternative diagnostic modalities and therapeutic procedures are now common practice in Europe, Asia, South America and other civilized countries around the globe.

Making the leap: clinical trial and anecdotal observation

There are two important phrases in classic scientific methodology: clinical trial and anecdotal observation. Clinical trial is evidence accumulated based on an assumption of a possible mechanism of therapy to be investigated. Anecdotal observation means that a treatment worked once or twice, and the mechanism may not be readily understood at that time. The bard of modern times says, “To succeed, or not to succeed—that is the question.” It is more useful to have a treatment that works and is not understood than to have a therapy that makes sense but ultimately fails. A beef steak placed over a black eye helps, but the cold and pressure of an ice pack would do better to reduce the pain and swelling. Likewise, dabbing tincture of iodine over a cut will sterilize the wound yet produce more tissue damage due to its high local tissue toxicity. The following example shows how the interplay between formal clinical study and anecdotal evidence can drive medicine forward.

The drug finasteride (Proscar®) was developed fifteen years ago as a miracle cure for progressive urinary symptoms of an enlarged prostate. Initial clinical trials showed it was useful and Proscar rapidly received FDA approval. Early studies also suggested that it might reduce prostate cancer risk. Anecdotal reports that it was only minimally effective began to appear and increase in number. New data also suggested men were developing serious cancers while on the medication. Finally, a critique of a large study recently concluded, surprisingly, that while the drug was somewhat useful in alleviating the symptoms of benign prostatic hypertrophy, and there was an overall 25% decrease in prostate cancer prevalence, there was a 68% increase in the frequency of high grade killing prostate cancers in the treated group. This report, published in the 2004 Journal of Urology by Dr. Patrick Walsh (Johns Hopkins Medical Center) underscores the interaction between clinical trials and anecdotal reports. A study from the National Cancer Institute on this subject was presented by Dr. Lucia in the 2005 issue of The Journal of Urology. It indicated that the high grade cancers (Gleason 8-10) induced by finasteride were limited to one side rather than both sides of the prostate gland thus validating Dr. Walsh’s findings. The wonder drug appeared to produce fewer nonlethal tumors but stimulate more aggressive killing cancers. Clearly more research must focus on the controversial area of cancers being aggravated by prescription medications.

The story does not end here. Since the evidence didn’t fit the theory, the facts were reinterpreted in the last few years. It is now felt that the increase in significant tumors was due to the shrinking of the enlarged prostate that made the more dangerous cancer easier to detect. The jury is still out in this trial and we need more data to come to a definitive conclusion. A major study on breast cancer demonstrated 10% of proven cancers disappeared after six years without treatment. Remember, the breast and prostate are both glands. Like breast cancers, we see some prostate cancers resolve without traditional medical treatments and this possibility deserves further clinical study.

David Hess in the Rutgers University Press publication (1999), Evaluating Alternative Cancer Therapies, quotes the following from medical scholar Robert Houson:

The FDA requires a convincing mechanism to obtain approval for clinical trials, and I think this is a completely unnecessary requirement. If there are clear indications of benefit in humans or animals, that should bypass the whole issue of mechanism. The point is that the investigators do not have to know the mechanism in order to corroborate the effect that is occurring. In cancer, case studies have a greater degree of validity than in other diseases. In cancer the rate of spontaneous remission is extremely low, so low that it is virtually zero. Therefore, if you have just a few cases, even only two cases, you have something that is significant and most likely meaningful. So, I consider what is being dismissed as anecdotal evidence, to be in cancer, actually an impressive proof of success because you can have much more detail in the case studies than you can in a clinical trial.

The same principle of anecdotal observation applies to advances in disease detection through imaging. In the 1980’s, when the state of the art sonogram equipment showed that doctors could see malignant lymph nodes (cancerous glands), I started a protocol with Cabrini Medical Center in New York City under the famed breast surgeon, Dr. Henry Leis. We scanned patients with breast cancer to see if the underarm lymph nodes were involved by tumor. Detection of these cancerous glands meant surgery was not indicated, since abnormal glands showed the cancer had spread too far for a local operation to be useful. The results of our investigation spared selected patients unnecessary surgery. The project broke new ground and showed that the sonogram accurately detected larger cancerous glands, thereby saving some patients from the operating room. We also discovered certain types of highly aggressive breast cancers seemed to shrink the breast instead of producing a lump. In these patients, the mammogram was read as “normal” even though the contracted breast tissue was hard as a rock at the physical examination. This variety of cancer produced scarring and retraction of the tissues as it grew. The mammogram was useless in the diagnosis, but because we were willing to “risk” applying a different technology we learned that the sonogram visualized them easily. Our leap of faith paid off. The hospital began a screening program for high-risk patients which in turn led to the discovery of malignancies at very early stages. This has increased the amount of surgery and decreased the spread of cancer, resulting in more favorable outcomes.

The experimental use of ultrasound technology led to an investigational clinical trial after anecdotal cases pointed the way to a specific treatment protocol. The same lymph node sonography is currently being used in Europe to determine the possible spread of other cancers, especially the deadly skin tumor malignant melanoma. If the major lymph nodes draining the tumorous area are unremarkable, extensive disfiguring biopsy may now be avoided. If an abnormal lymph node is found, it may be needle biopsied in a few minutes, with the cells immediately analyzed by a cytopathologist. This real time biopsy/analysis may render unnecessary a complicated combination of radiation with surgical biopsy to better stage the spread of disease throughout the lymph node chain.

My high school chemistry teacher in 1958 was Mr. Marantz. As an eager student, I had looked up some information in a journal and proudly told him I had done some “research” on a topic. He looked at me sternly, saying, “Research is not finding something in a book. Research is being committed to a project and observing and analyzing what happens during the investigation.” He then related his story of how he became a school teacher. He was a topnotch industrial research chemist before he entered a teaching career. The New Jersey pharmaceutical plant he worked in was located alongside a river. Three of the walls of the laboratory were steel and concrete. The fourth wall, facing the river, was made of plasterboard and wood. He invented new substances by taking risks and boldly trying unexplored chemical pathways. From time to time there would be a fire or an explosion. On three sep...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Author’s Background
• Foreword
• Preamble
• Prologue
• Chapter 1 Taking the Risk to Change
• Chapter 2 Understanding the Facts
• Chapter 3 Medical Truths Are Not Sacred Cows
• Chapter 4 Practical Anatomy, Pathology and Diagnosis
• Chapter 5 Trust Experience and Gather Information
• Chapter 6 Focal Laser Ablation of Prostate Tumors
• Chapter 7 Assessing Treatment Response
• Chapter 8 Reflections on Conventional Treatments
• Chapter 9 Promising Scientific Breakthroughs
• Chapter 10 Boosting The Body’s Defenses
• Chapter 11 Cancer Screening Pro’s and Con’s
• Chapter 12 An Open Mind Is Your Best Friend
• Epilogue
• Acknowledgments
• Appendices